Dr. Nancy Kay

What is a Veterinary Specialist?

I participate in a list serve for veterinarians who specialize in internal medicine. The list serve “topic de jour” concerns veterinarians who are general practitioners (also known as family veterinarians), yet bill themselves as “specialists” in specific venues such as surgery, dentistry, or cardiology. The responses have been strongly disapproving, and here is the reason why: The American Veterinary Medical Association dictates that the term “specialist” be reserved only for veterinarians who have completed all of the requirements to become a “diplomate” within a specialty organization. What must a veterinarian do to become an official specialist/diplomate? Trust me, it is a long and arduous process! After graduating from veterinary school, wannabee specialists must complete a minimum three-year internship and residency training program, author publications in peer reviewed journals, and pass some insanely rigorous examinations specific to the specialty they are pursuing. (Note that the requirements differ for those who become specialists in complementary/alternative medicine fields of veterinary medicine such as homeopathy, acupuncture, chiropractic, and Chinese herbs.) If one is successful in completing this rigorous and extensive training they achieve “board certification” status and are deemed to be “specialists” or “diplomates” within their chosen specialty. This is much like the process physicians go through to become specialists.

The world of veterinary specialists has grown by leaps and bounds. Much like Starbucks®, if there’s not already a group of specialists in your community, there likely will be soon! Veterinary specialists are found in university teaching hospitals and in some private practices. They often “cohabitate,” sharing specialty staffing, equipment and laboratory services with specialists in different areas of expertise. When this is the case, you, the lucky client, end up with access to multiple specialists under one roof. Not only is this convenient, it also focuses a lot of brainpower and experience on your pet- group discussions about patients (medical rounds) typically occur daily in such specialty hospital settings.

When might you need the services of a veterinary specialist? Just as your family physician refers patients to specialists, your family veterinarian should be considering referral in the following three situations:

A second opinion is desired by you or your veterinarian. Yes, you definitely have the right to request a second opinion. I know it can be tough telling your vet you would like a second opinion, but as your beloved pet’s medical advocate, you are obligated to do so just as soon a your “gut” starts suggesting that a second opinion makes sense. I encourage you to read the chapter called, “A Second Opinion is Always Okay” in Speaking for Spot- it will provide you with plenty of helpful coaching about how to tactfully broach the subject with your veterinarian! Hopefully your vet has established relationships with local specialists- the kind she would trust to take good care of her own dog should the need arise. Not all family veterinarians are keen on “letting go” of their patients, so self-referral might be your only way to seek out the help of a specialist.

Help is needed to figure out what is wrong with your pet. Specialists have advanced diagnostic tools (ultrasound, endoscopy, CT imaging, MRI scans, etc.) and have developed the skills to use them. Additionally, because of their extensive experience with challenging cases, specialists often have the ability to hone in on a diagnosis in the most direct and expedient manner.

Your vet doesn’t specialize in the disease your pet has or the therapy he needs. Just as with our own health issues, treatment is ideally managed by someone who works with that particular disease issue day in, and day out, and regularly pursues continuing education pertaining to that disease.

How can you tell if a particular veterinarian is truly a specialist? Simply examine the initials following his or her name. See the list of specialties and their corresponding initials below. For example, if you look at the initials following my signature (ACVIM), you can tell that I am a specialist in The American College of Veterinary Internal Medicine. To learn more about any of these areas of specialization, pay a visit to the websites. Those listed below are within the United States, but you will find comparable organizations in many other countries or continents.

Have you ever taken your pet to a veterinary specialist? Have you ever wanted to do so, but had trouble getting “buy in” from your family veterinarian? If so, please share your experience. I’d love to hear from you.

Diplomate, ACVIM

Internal medicine (acvim.org)

Diplomate, ACVIM, Cardiology

Cardiology (acvim.org)

Diplomate, ACVIM, Oncology

Oncology (acvim.org)

Diplomate, ACVIM, Neurology

Neurology (acvim.org)

Diplomate, ACVS

Surgery (acvs.org)

Diplomate, ACVD

Dermatology (acvd.org)

Diplomate, ACVR

Radiology (acvr.org)

Diplomate, ACVO

Ophthalmology (acvo.org)

Diplomate, AVECC

Emergency and critical care (acvecc.org)

Diplomate, ACVA

Anesthesiology (acva.org)

Diplomate DACVB

Behavior (dacvb.org)

Diplomate, ACVN

Nutrition (acvn.org)

Diplomate, AVDC

Dentistry (avdc.org)

Diplomate, ACT

Theriogenology (theriogenology.org)

CVA

Veterinary acupuncture (Ivas.org)

TCVM

Chinese veterinary medicine (tcvm.com)

AVH

Homeopathy (drpitcairn.com) or (theavh.org)

ACVA

Chiropractic (animalchiropractic.org)

CCRP

Canine rehabilitation (caninerehabinstitute.com)

Best wishes to you and your four-legged family members for abundant good health,

Nancy Kay, DVMDiplomate, ACVIMRecipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics AwardRecipient, 2009 Dog Writers Association of America Award for Best BlogRecipient, 2009 Eukanuba Canine Health AwardAuthor of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

9 Comments on “What is a Veterinary Specialist?”

We are grateful to live in an area where not only specialists practice, but enlightened general practitioners refer patients to those specialty practices when necessary.
Max gradually began acting confused, tripping up, dragging his front paws when walking. We took him to his regular vet who followed up with x rays and routine blood work. When everything checked out normally he sent us to a ACVIM Neurology specialist who did an MRI and spinal tap. The disease and its cause was diagnosed within the week. (Cryptococcal meningitis, caused by bird poop! Got to love a spaniel with his nose to the ground…) Max began to improve almost immediately when treatment was started and today he is active and walking and behaving normally. (After 8 months he is still on anti fungal drugs but his blood work keeps improving).
We are so grateful that we had access to a skilled specialist with modern diagnostic tools as well as an enlightened “family” vet. Max is a very young 10 and we look forward to many more healthy years with him.

Dr Kay,
Thank you so much for speaking not only for the pets in this world, but also for all specialists who work hard to provide excellent care for pets and maintain great relationships with the referring vets. Your book should be required reading for all pet owners and general practitioners.

Let’s see…we’ve had experience with two Oncologists, a Homeopathic specialist, a Veterinary Behaviorist and a Cardiologist. One dog with Cancer (we moved between the 1st round of Chemo & the 2nd, so two Oncologists — one on each coast), one dog with Generalized Anxiety Disorder (Homeopathy and the Vet Behaviorist) and a cat with a heart murmur. I have had great support from my regular Veterinarians and no problem getting the referrals needed. Of course, the issues we have are pretty obvious — no question about diagnosis and I do live in a pretty major Metropolitan area, but I’ve been very happy with my experiences.

We specialize in working with owners to solve behavior problems with their dogs, cats, and parrots. Often, we require a prospective client to visit their veterinarian before we see them to rule out any problem such as pain, irritation, infection, etc. When possible, we refer to Board Certified Veterinary Behaviorists. Last time I checked, there were fewer than 50 of these specialist in the United States. For example, we don’t have a Veterinary Behaviorist in the state of Washington (even at our veterinary school in the eastern part of the state). There is however, a Veterinary Behaviorist in Oregon. We look forward to seeing this shortage of Veterinary Behaviorist to improve because finding a veterinary specialist can make all the difference! Here’s an article that wrote about how to find a credentialed professional to help with animal behavior problems: http://companionanimalsolutions.com/blogs/qualifications-to-look-for-in-an-animal-behavior-specialist/

We are fortunate to live in an area that offers not just a specialist in all disciplines but often a choice of specialists so we could pick the one that best fit our needs. Our dog Chris was diabetic with cataracts, poorly cemented corneas, severe heart disease, and skin issues and we took advantage of specialty care for all of those things.

We did not rely on an Internal Medicine Specialist as I was able to manage his diabetes with home blood glucose testing. But throughout the time Chris had diabetes induced cataracts, we worked with an ophthalmologist, especially since he suffered from slow-healing corneal ulcers. We tackled several difficult skin problems with a dermatologist. And Chris’ heart disease, which included six different diagnoses, was treated by a cardiologist. We also had one occasion to consult a wonderful neurologist when Chris suffered an episode of weakness and nystagmus that was eventually diagnosed as a likely TIA.

Without exception, we found the specialists to be invaluable to Chris’ care and I don’t think he would have made it to 14.5 years of age without their help.

We have been blessed as well to have a veterinary who frequently consults with and is happy to refer to a specialist. The TIA symptoms looked, in some respects, like vestibular syndrome but other symptoms did not match it and our vet was quick to refer us to the neurologist, who we were able to see within an hour and a half of seeing the vet.

While I want a vet who is as capable as possible, I don’t want a vet who can’t let go of a case when it’s outside his/her skill level. It is easy to run up a very large bill with a general practice vet who is facing something outside her/his capabilities and might well save some money for the client by referring to a specialist sooner rather than later.

Long story short, I loved every one of Chris’ specialty vets and I credit them with giving him a longer life and a higher quality of life.

Asking for a referral to a specialist immediately changed the attitude of the vet who blithely told me that my dog’s uveitis wasn’t caused by her out-of-control diabetes (the 99% likely explanation) but to cancer just on the basis of guessing. She suddenly realized my dog needed about $200+ more in testing before going to the opthamologist. Apparently it’s okay to BS a client but you don’t want an expert to know you’re full of it. I haven’t been back to that vet since, and learned the hard way that her colleagues at that practice are just as bad.

Thanks for this informative post. Now I know what the initials mean! Yes, I have used a specialty practice with good results. My springer Emily had elevated blood calcium, revealed during a routine checkup. My local vet suspected cancer although there were no other clinical signs. After many tests, including a bone marrow aspiration (negative) he was completely stumped. He referred us to a specialty practice where an ultrasound showed what they thought was a tiny growth on Emily’s parathyroid gland, but even the specialists weren’t sure. They operated and sure enough, that was the culprit. After removal of the benign growth, her calcium went to normal and stayed there. The specialist said it was a rare condition. I wished I had been referred to them much sooner, but was thankful for a good outcome. I will add that initially I had to push my local vet for the referral, but he knew he had exhausted his options. He was happy to have the mystery solved!
Laurel, celebrating the love of dogs at http://laurelhuntbooks.com